Dural Closure Techniques and Cerebrospinal Fluid Leak Incidence After Resection of Primary Intradural Spinal Tumors: A Systematic Review.

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-08-01 Epub Date: 2023-07-24 DOI:10.1097/BSD.0000000000001491
Arjun Syal, Francesca M Cozzi, Sima Vazquez, Eris Spirollari, Alexandria F Naftchi, Ankita Das, Christina Ng, OluwaToba Akinleye, Thomas Gagliardi, Jose F Dominguez, Arthur Wang, Merritt D Kinon
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Abstract

Study design: This is a systematic review of primary intradural spinal tumors (PIDSTs) and the frequency of postoperative cerebrospinal fluid (CSF) leaks.

Objective: This study aimed to compare CSF leak rates among techniques for dural watertight closure (WTC) after the resection of PIDSTs.

Summary of background data: Resection of PIDSTs may result in persistent CSF leak. This complication is associated with infection, wound dehiscence, increased length of stay, and morbidity. Dural closure techniques have been developed to decrease the CSF leak rate.

Methods: A PubMed search was performed in 2022 with these inclusion criteria: written in English, describe PIDST patients, specify the method of dural closure, report rates of CSF leak, and be published between 2015 and 2020. Articles were excluded if they had <5 patients. We used standardized toolkits to assess the risk of bias. We assessed patient baseline characteristics, tumor pathology, CSF leak rate, and dural closure techniques; analysis of variance and a 1-way Fisher exact test were used.

Results: A total of 4 studies (201 patients) satisfied the inclusion criteria. One study utilized artificial dura (AD) and fibrin glue to perform WTC and CSF diversion, with lumbar drainage as needed. The rate of CSF leak was different among the 4 studies ( P =0.017). The study using AD with dural closure adjunct (DCA) for WTC was associated with higher CSF leak rates than those using native dura (ND) with DCA. There was no difference in CSF leak rate between ND-WTC and AD-DCA, or with any of the ND-DCA studies.

Conclusions: After resection of PIDSTs, the use of autologous fat grafts with ND resulted in lower rates of CSF leak, while use of fibrin glue and AD resulted in the highest rates. These characteristics suggest that a component of hydrophobic scaffolding may be required for WTC. A limitation included articles with low levels of evidence. Continued investigation to understand mechanisms for WTC is warranted.

Level of evidence: Level 3.

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硬膜封闭技术与原发性硬膜内脊柱肿瘤切除术后脑脊液漏的发生率:系统回顾
研究设计:这是一篇关于原发性硬脊膜内肿瘤(PIDSTs)和术后脑脊液(CSF)漏频率的系统性综述:本研究旨在比较PIDSTs切除术后硬脑膜防水闭合(WTC)技术的脑脊液漏率:背景数据摘要:PIDSTs切除术可能会导致持续性CSF渗漏。这种并发症与感染、伤口开裂、住院时间延长和发病率有关。目前已开发出硬脑膜闭合技术来降低 CSF 渗漏率:在 2022 年进行了一次 PubMed 搜索,纳入标准如下:英文撰写、描述 PIDST 患者、明确硬膜封闭方法、报告 CSF 渗漏率、2015 年至 2020 年间发表。结果共有 4 项研究(201 名患者)符合纳入标准。其中一项研究使用人工硬脑膜(AD)和纤维蛋白胶进行 WTC 和 CSF 转移,并根据需要进行腰椎引流。4 项研究的 CSF 漏率不同(P =0.017)。使用 AD 和硬脑膜闭合辅助器(DCA)进行 WTC 的研究与使用原生硬脑膜(ND)和 DCA 的研究相比,CSF 漏出率更高。ND-WTC与AD-DCA或任何ND-DCA研究的CSF漏出率均无差异:结论:切除 PIDST 后,使用 ND 的自体脂肪移植导致 CSF 泄漏率较低,而使用纤维蛋白胶和 AD 的 CSF 泄漏率最高。这些特点表明,永利国际娱乐可能需要疏水支架的成分。局限性包括证据水平较低的文章。有必要继续调查以了解 WTC 的机制:证据等级:3 级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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